Manchester Foundation Trust, United Kingdom.
St George's Hospital, London, United Kingdom.
Br J Oral Maxillofac Surg. 2024 Sep;62(7):595-603. doi: 10.1016/j.bjoms.2024.04.012. Epub 2024 May 3.
The objective of this review was to conduct a systematic review and meta-analysis on the efficacy of ICG (indocyanine green) for sentinel lymph node (SLN) detection in head and neck melanoma. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement standards (PRISMA) were followed when conducting this review with a comprehensive search of the following online databases; Google Scholar, PubMed, MEDLINE, CINAHL, and CENTRAL, World Health Organization International Clinical Trials Registry (http://apps.who.int/trialsearch/), ClinicalTrials.gov (http://clinical-trials.gov/), and the ISRCTN registry (http://www.isrctn.com/). Nine studies met the inclusion criteria and results were reported with forest plots at 95% confidence intervals. Primary outcomes of interest included the localisation rate for sentinel node biopsies in head and neck melanoma using ICG and compared with other adjunct modalities. Secondary outcome measures included false negative rates as well as sensitivity rates for nodal detection with radiocolloid as well as blue dye. ICG reported an overall sensitivity rate of 95% with an untransformed proportion metric analysis (0.950, 0.922, 0.978 (95% CI)). It demonstrated a superior detection rate to blue dye (Odds ratio 15.417, 95% CI, 4.652 to 51.091, p < 0.001) and a comparable localisation efficacy to radiocolloid (Odds ratio 1.425, 95% CI, 0.535 to 3.794, p = 0.478). The sensitivity rate for radiocolloid utilisation in isolation was 90.6% (untransformed proportion metric, 0.906, 0.855, 0.957) and blue dye was 48.7% (untransformed proportion metric, 0.487, 0.364, 0.610). This is the first meta-analysis on the efficacy of ICG for sentinel node detection in head and neck melanoma. The authors advocate for a dual modality approach with ICG and radiocolloid to mitigate the inherent limitations of both methods when conducting sentinel node retrieval for head and neck melanoma. Further high-quality randomised trials are needed to improve the current evidence base.
本综述的目的是对吲哚菁绿（ICG）在头颈部黑色素瘤前哨淋巴结（SLN）检测中的疗效进行系统评价和荟萃分析。本综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）标准，全面检索了以下在线数据库：Google Scholar、PubMed、MEDLINE、CINAHL 和 CENTRAL、世界卫生组织国际临床试验注册平台（http://apps.who.int/trialsearch/）、ClinicalTrials.gov（http://clinical-trials.gov/）和 ISRCTN 注册平台（http://www.isrctn.com/）。9 项研究符合纳入标准，结果以森林图报告，置信区间为 95%。主要研究结果包括使用 ICG 对头颈部黑色素瘤进行前哨淋巴结活检的定位率，并与其他辅助方法进行比较。次要研究结果包括放射性胶体和蓝色染料检测淋巴结的假阴性率和灵敏度。ICG 报告的总体灵敏度为 95%，未经转换的比例度量分析为 0.950、0.922、0.978（95%CI）。与蓝色染料相比，它显示出更高的检测率（比值比 15.417，95%CI，4.652 至 51.091，p<0.001），与放射性胶体的定位效果相当（比值比 1.425，95%CI，0.535 至 3.794，p=0.478）。单独使用放射性胶体的灵敏度为 90.6%（未经转换的比例度量，0.906、0.855、0.957），蓝色染料为 48.7%（未经转换的比例度量，0.487、0.364、0.610）。这是头颈部黑色素瘤前哨淋巴结检测中 ICG 疗效的首次荟萃分析。作者主张采用 ICG 和放射性胶体的双模态方法，以减轻这两种方法在头颈部黑色素瘤前哨淋巴结检索中固有的局限性。需要进一步开展高质量的随机试验来提高当前的证据基础。
